Inhaled nitric oxide mitigates need for extracorporeal membrane oxygenation in a patient with refractory acute hypoxemic respiratory failure due to cardiac and pulmonary shunts

Brandon Nokes, Beeletsega Yeneneh, Jake Maddux, Ryan C. Van Woerkom, Amelia Lowell, Hannelisa Callisen, Bhavesh Patel, Fadi Shamoun, F. David Fortuin, Patrick DeValeria, Ayan Sen

Research output: Contribution to journalArticlepeer-review

Abstract

We present a case of refractory acute hypoxemic respiratory failure due to influenza B pneumonia with concomitant large intra-atrial shunt (IAS) and severe pulmonary regurgitation in a patient with Saethre-Chotzen syndrome with prior pulmonary homograft placement. Our patient's hypoxemia improved with inhaled nitric oxide as an adjunct to mechanical ventilation without requiring extracorporeal membrane oxygenation, and eventually a percutaneous closure with a 30 mm CardioSeal patent foramen ovale closure device was accomplished. However, his peri-procedural hospital course was complicated by occluder device migration, which was retrieved with eventual surgical closure of the PFO. Nitric oxide has not demonstrated any statistically significant effect on mortality and only reported to transiently improved oxygenation in patients with hypoxemic respiratory failure. Our case demonstrates that inhaled nitric oxide may have a role in acute hypoxemic respiratory failure in a case with significant cardiac and pulmonary shunts.

Original languageEnglish (US)
Pages (from-to)98-102
Number of pages5
JournalRespiratory Medicine Case Reports
Volume24
DOIs
StatePublished - Jan 1 2018

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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